Cancer centers across the United States have had to be creative when it comes to moving medications around between sites as drug shortages have spiked and decreased in different regions during the COVID-19 pandemic. This was the topic of a recent Association for Value-Based Cancer Care (AVBCC) webinar, moderated by Niesha Griffith, RPh, MS, FASHP, Chief Pharmacy Officer, Columbus, OH.
“We have found some solutions where we are able to share, not only intra-facility but with external partners as well if they are within the same state,” said Chris Marcum, PharmD, Vice President of Enterprise Pharmacy, Cancer Treatment Centers of America. “A lot of the critical care medications are still difficult for us to get across the nation.”
Dr Marcum predicted that although intravenous immune globulin (IVIG) is currently not in short supply, that could change very quickly. “We know that donations are down 20% to 30%, and the manufacturing cycle is long-term for IVIG. So, what will the end of this year and next year look like? If things don’t turn around—and we’re not expecting them to—supply chain issues for IVIG will be significantly worse in the first half of 2021,” he said.
Bhavesh Shah, RPh, BCOP, Director of Specialty and Hematology/Oncology Pharmacy, Boston Medical Center, noted that a lot of plasma is going to the treatment of patients with COVID. “If there is a surge and stay-home order in any given area, there will be even lower plasma donor levels in that region. That is definitely a big concern for oncology and other major disease states treated with IVIG.”
With an increasing number of patients participating in follow-up visits by telehealth and even receiving maintenance therapies in the home setting rather than in hospitals or outpatient centers, oncology pharmacy staffing has adapted, Dr Marcum said. “We have added video consultation services, which have been very helpful. Our technicians schedule these appointments for patients and educate them in advance on how to use the platform so that the actual consultative session with pharmacists can be most productive.”
In 2019, the Harvard Business Review highlighted Memorial Sloan Kettering Cancer Center’s pilot program, InSight Care, which provides digital team-based care for patients with cancer. This program is designed to reduce patients’ risk for hospitalization between outpatient visits. “We adapted that platform, along with some others, in a hurry to help manage our patients who were diagnosed with COVID but weren’t sick enough to be admitted to the hospital,” said Scott Freeswick, MS, PharmD, Vice President and Chief Pharmacy Officer, Memorial Sloan Kettering Cancer Center. “When a patient is diagnosed with COVID, they are added to this system and receive daily questionnaires about their symptoms. It was a heavy lift to get all this information into the electronic medical record in a short period of time.”
A shift to providing more care in the home has prompted concerns about several potential challenges, including segmentation of care, the safety of individual home environments, and the staff who are administering therapies in the home. “It’s interesting to see some of the drugs on the list for potential home infusion that we as pharmacists don’t always consider benign and safe to be administered in the home,” noted Dr Griffith. “People who are oncology trained and able to recognize unique symptoms need to be able to lay eyes on these patients. Who is going to be doing the monitoring and the follow-up? Who holds responsibility for what?”
Another key issue for oncology pharmacies in the era of COVID-19 is inventory management. “There needs to be some type of action plan from vendors—our primary and secondary wholesalers, to support institutions more effectively in terms of future surges and help us get ahead of them,” Dr Shah said.